Should you finish a course of antibiotics?

UK experts have questioned whether a full course of antibiotics is needed

UK experts have questioned whether a full course of antibiotics is needed

In a startling reversal of accepted medical practice, experts writing in the British Medical Journal (BMJ) on Thursday said the traditional "complete the course" message created to avoid antibiotic resistance should be discarded.

The report from ten specialists in infectious diseases from Oxford University and Brighton and Sussex Medical School said the current advice is not backed up by evidence.

If you treat for too short a time, you may end up enriching the environment for antibiotic resistant organisms, she explained, "and the relative proportion of drug resistant bugs becomes higher, higher than the host can ever deal with, and then this infection can reemerge as drug resistant". "We want to only give them to people who need antibiotics to get better", he said.

The experts say there has been too little research into the ideal length of a course of antibiotics, which also varies from one individual to the next, depending in part on what antibiotics they have taken in the past.

When he accepted the Nobel Prize for his work in 1945, Fleming, who had noted that bacteria could mutate when exposed to the new drugs, delivered a vivid speech describing an imaginary patient with a throat infection who had failed to complete his course of antibiotics. In many previously healthy patients with acute infections, letting them stop the antibiotics once they feel better has considerable appeal.

Not according to a British team of microbiologists and infectious disease experts. There's evidence that antibiotic courses could be shorter, which would help prevent the rising global threat of antibiotic resistance, the analysis released Wednesday argues.

"This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous".

Royal Pharmaceutical Society spokesman and consultant pharmacist Dr Kieran Hand, said the article was a welcome opening of the debate in the United Kingdom on the relationship between the length of a course of antibiotics, efficacy and resistance. Prof Peter Openshaw, president of the British Society for Immunology and professor of experimental medicine at Imperial College London said it supported the idea that antibiotics might be used more sparingly. "It remains astonishing that apart from some specific infections and conditions, we still do not know more about the optimum duration of courses or indeed doses in many conditions, yet this dogma has been pervasive and persistent".

Top Dem's aide under investigation, nabbed trying to leave US
But he must wear a Global Positioning System monitor, abide by a curfew and stay within a 50-mile radius of his home in Virginia. Yes, clearly the investigation by the FBI, Capitol Police and the numerous piles of evidence all come down to Islamophobia.

"No one has questioned (this advice) for all this time", said Peto.

"The evidence for "completing the course" is poor, and the length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies", Lindsay said.

The official advice on whether or not it's essential to complete a course of antibiotics won't be likely to change immediately.

"Recommended courses of antibiotics are not random". For an uncomplicated case of an urinary tract infection, for example, an antibiotic regimen is as short as three days.

"We are concerned about the concept of patients stopping taking their medication mid-way through a course once they "feel better", because improvement in symptoms does not necessarily mean the infection has been completely eradicated", she explained.

"I recommend that if a patient is feeling better while taking a course of antibiotics, that the patient or the patient's family should consult a physician to see if those antibiotics can be safely stopped", she says. "Changing this will simply confuse people".

Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, agreed that doctors' advice to patients needs to change. "To update policies, we need further research to inform them", she told the Guardian.

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